89. Ralph, no.

value

Wanted: philosopher.

The highway code was not written by psychologists. So there is very little recognition of the role of the ‘automatic’ brain in terms of handling most driving duties. The code would have us believe that thinking comes before acting, but this is rarely the case day to day. Driving might start out as thoughtful when people first learn, but it soon becomes a habit.

By the time the driving test is over, the autopilot takes over for the next 70 years of carefree motoring. But all the time we see little bits of degeneration, such as cutting corners, running over kerbs when parking and dyslexic indicator work, on occasions where mental functioning goes a bit windows vista.

In general, once the code is learned the mantra goes like this: First, behave; second, think; third, feel. And this would be a good mantra for living your life, if only there was a code of behaviour that was properly itemised, bullet-pointed and illustrated.

But there is no such clear code, only things like custom and manners. Like letting the person with one item in the basket go on ahead in Lidl. But what about the person behind him, and the next person? What about the person with two items? Such dilemmas are meat and potatoes for the ethics panel.

Religious texts are not specific enough. Try searching ‘what car would Jesus drive?’ for instance. Though it has been argued that Jesus and the apostles were in one Accord, it’s not  wise to interpret scripture so literally.

Am I the only person to feel our Ethicists are letting us down?

Come on, Moral Maze, your show is so tired. It’s crying out for a road-show format. Let’s get the ethicists out on to the streets and help solve real life moral dilemmas. Help us deal with issues like parking meters and beggars.

In Dublin City Centre there are severe parking restrictions. It is necessary to pay by phone using either a text message, phone call or website. It turns out that all three options are impossible if you don’t have an Irish mobile phone number. Neither do the machines seem to  accept coins. Worse than this, there are clear signs of wheel clamping in progress. Like rows of clamped cars covered in moss.

Also in Dublin, there are quite a few beggars. Most adopt passive body language, sitting on the pavement, leaning against a wall, with a polystyrene cup held in both hands, tilted upwards. I didn’t see any money in any of the cups and people seemed to ignore the beggars like they do in every city. I have no idea how many beggars were ‘genuine’ as opposed to being run by gangs.

As I understand it, people are reluctant to give to beggars, not because the helping agencies have advised us not to, but rather because many of them are felt to be running a con. If it is a con though, why adopt a near-catatonic pose, rather than say, stand up, maintain eye contact, talk to people, all strategies that seem to increase donations?

In Dublin, it would be nice to give more money to the parking people and the beggars, but you can’t. Not without a lot more information.

Ethical experiments feed in the background information drip by drip, but on the streets no-one hands out a contextual vignette, not even a placard.

One approach that seems to work is to hand around notes containing a short account of why a donation is requested. Hand out notes politely round a bar or restaurant, giving people half a minute to digest the information, then quietly go round with a paper cup, getting out just before the staff throw you out. Something like: ‘my Volkswagen uses more fuel than I expected and I need an extra bit to pick my children up from the chemotherapy day unit. Just £1.09 will buy a litre of diesel. Please be generous and God bless’

I wondered if this type of beggar used to be teachers and still love to hand out and collect papers. Or possibly psychology students, trying to pay their exorbitant tuition fees.

But can you be sure they are not genuine? Are you really going to ask the names and addresses and ages of their children, where they go to school and why they’ve been left at the chemotherapy unit all day, as your Safeguarding Training says you should? Or will you just give them a few of your Rupees or Turkish coins you keep for such occasions?

On TV last week was a long piece suggesting that large numbers of students were selling sex to ‘sugar daddies’ to help them through college. For some reason this was blamed on the movie Frozen, on the basis that girls were trained to become princesses rather than agents of their own destiny.

http://news.sky.com/story/1576077/sugar-babies-students-selling-sex

Sugardaddy websites make statements like this one:

‘Wondered what the sugardaddy life is like?  Well, he won’t be ignoring you whilst watching the football for a start.  For a sugardaddy, he has made his investment and his focus will be on you.  So whilst the lads are down the pub, your older, richer man may take you to Cannes in his private jet for dinner or to a luxury spa for some couple treatments.  Either way, it is guaranteed your man will know how to take care of you and it will be better than ever before’

Anyway, I’m not sure whether the breakfast TV panel considered this issue carefully enough and I hope the Oxford Centre for Practical Ethics will give us a better opinion on whether it’s OK or not. At first glance, the carbon footprint looks excessive, having to eat in Cannes all the time.

Doctors are taught medical ethics according to four basic principles: doing good, not doing harm, personal autonomy and justice. The rule is: look at these four aspects and balance them up as you like, adding a twist of lemon, to justify exactly what you were going to do anyway.

Doctors have a tendency towards utilitarianism and have no trouble hypothetically shooting down a hijacked airliner that is about to crash into a football stadium (depending a little on which stadium, who is playing and the scoreline). But we struggle with dilemmas where the outcomes are uncertain.

Like this one for instance, I came across in Sheffield City Centre this week.

To set the scene, try arriving at 4.20 at one of the main car parks close to City Hall, and work out how much to pay and display. 50p gets you 30 minutes, but after 4.30 it’s only £2 to stay until 8am next day. I’ll give you a moment to think about that.

There seemed to be three options: hang around for ten minutes and pay £2; pay 50p and come back within half an hour and pay £2 more; or try paying £2.50 and seeing what happens. The machine does not give change. Over to you, panel.

Option 1 strikes me as lacklustre. It’s for people who think 10 minutes passes quickly, which means older citizens and people with distorted time perception due to cannabis use.

Option 2 is a little bit inconvenient , but could work, especially if you bought some fish from the shop nearby, the one where tangled lobsters cavort in the front window display. But do you really want to leave live seafood in your car, quite possibly roaming about and scuttling under the seats?

Option 3 on the other hand is a little bit bold, it’s one for the poker player. It’s quite possible that something happens at 4.30 that re-sets the whole system of time, so that the universe ceases to exist, or even worse, you could lose £2.

It takes me about three minutes to decide – ironically this delay in itself has tilted the balance in favour of Option 1, now only 7 minutes is at stake.

I go for option 3 on the basis that it is a scientific experiment and it will cost £2 to conduct or maybe less.  Options 1 and 2  are for potheads and anancasts and option 3 is for square jawed people with firm handshakes and a steady gaze. This is my contribution to the science budget for today.

I pay £2.50 and hit the green button. Let the chips fall where they may.

I look at the ticket and it says ‘Expires 1853’.

That’s a bad outcome. For that to work I’d have to come back before 1853 and pay another £2. That’s just not going to happen and I decide to take a risk, either that no-one is checking or if they do, I’ll write a crawling letter to the parking appeals department explaining the situation and begging for mercy.

I know what you’re thinking. If I believe this kind of problem is worth even considering for a minute in a world where terrible things are happening, like massacres and planes falling out of the sky, then surely I’m crying out for Ralph McTell to take me by the hand and lead me through the streets of London and show me something that will make me change my mind.

Just as I think that, I realise that a female person has approached from behind and is talking to me. And this is when I really needed Ralph McTell to put me right. Either that or The Handbook of Practical Ethics.

I turn to listen to the lady. I am not working, but the psychiatrist within me has the meter running. She is well spoken and nicely dressed, low to mid thirties in age. She does not seem affected by substances and her talk is normal in form and content. She tells me she feels terrible approaching strangers, but she has just been to the police station having lost both her handbag and mobile phone in a shop. The police, to her surprise, have been extremely unsympathetic and not offered any help. She tells me she is a Business Studies student at Hallam University. She goes on to say she needs to collect £26.40 that evening so she can buy a bus ticket home to Birmingham.

She seems plausible, but as she continues, a few things don’t seem to quite add up. She is carrying a notebook, which she shows me, but only one page has writing on it. She has written the bus times and price and a few other notes, very neatly, but in rather childish script. Handed out to her by her gang – boss handler, sitting in his gang – boss Mercedes just round the corner, a dark thought says.

I’m thinking:  it’s not the way people usually write notes, which is more of a doodle format. Plus, why would a business studies student be starting her studies in mid November. And why would you approach people in a car park, rather than say, the students’ union?

And I remember reading about studies featuring psychology students, posing as nicely spoken people who have lost their wallets, approaching strangers at London stations for help and usually met with very positive and generous reactions. I wondered if this person might be repeating this or a similar study and deeper down I wondered if I was being recorded or filmed. Subsequently I found that Youtube features lots of Rich Beggar social experiments, like the man with a new red Mercedes who solicits 50c for a parking meter.

But there was still a chance she could be genuine, and not a con artist, researcher, addict or beggar.  

I decided to give her a small amount of money, £5, based entirely illogically on the odds of her story being true, 20% give or take. Most people I’ve talked to think that was overgenerous. Wiser heads tell me this was an obvious scam.

Furthermore, ethical decisions can’t be made on the basis of percentages of likelihood. Paying £5 was generous if the lady was begging and ungenerous if she was for real. Generally we are advised not to give money to beggars and certainly not to give money to con-artists. There is an ethical basis to this in as far as giving money is not helpful, may do harm and is unjust.

I’m pretty sure I’ve failed the ethics module this time. ‘Didn’t think it through properly’ is scrawled all over the paper in the red biro of morality.

There is a code that says don’t give to beggars, but there is no code for dealing with unexpected events such as people in pub car parks offering to sell you fish or firewood. To protect against scams I suggest one simple principle. Only two groups of people bother – legitimately- to dress impeccably nowadays: car salesmen and funeral directors.

If you are approached by an unaccountably well dressed person and that person is neither of these, then walk away. McTell’s tyranny must end.

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88. Making sense of everything that’s ever happened.

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A service user, just hoping the CQC will make an unannounced visit.

There’s a backlash against drug therapy and a lot of people hate the fact that life expectancy has increased and there are effective treatments for cancer and diabetes. It’s just not natural is it? It’s no work at all just to take a tablet once a day with a glass of chilean merlot. It’s just inherently non-puritanical, especially as medicines don’t taste horrible any more.

Sadly pharmacists and drug companies won’t pretend their products are made out of tree bark or geranium leaves, they won’t put them in medicine bottles, they won’t colour them green – apart from Methadone, which still comes in a retro package – they won’t use the word Potion and they won’t make it taste like socks. Instead they almost celebrate the industrial origins of medicines, so that they are packaged and named like computer parts. Try a course of Celeron, and move up to Radeon if there’s no improvement after 6 weeks.

The market is wide open for a no pain no gain therapy, like the training montages from the Rocky movies, but instead of physical punishment, experts have come up with a therapy that’s more like school detention: History Therapy.

‘Historian and broadcaster Dan Snow and psychologist Richard Bentall get to the root of 21st century melancholy, and propose a cure’, we are promised

They will ask: Does meditating on the lives of our ancestors help us get a better sense of perspective toward our own problems? Can history nourish and console? Is the study of history, in short, a form of therapy?

They are putting History, in a bottle, on your tablet shelf, between Vitamin G and Vitamin I. It’s only £30 to attend the history session, which is less than the price of 100 Prozac tablets. Just remember that history is far more difficult to flush away.

I didn’t say this about Dan Snow and I’m quite scared about repeating it online, but some historians don’t think he’s a proper historian:

‘he routinely refers to himself as a historian when he doesn’t have a PhD or equivalent and therefore has not done the years of original archival research that professional historians have undertaken and then he takes our research and re-hashes it without any credit. And gets his facts wrong but still continues promoting himself as an expert. I think he is a dick and every time I hear the BBC refer to him as a historian I shout “No he fucking isn’t!

(http://gasheadau.blogspot.co.uk/2015/05/a-delightful-discussion-of-self-made.html)

Please, proper historians, try being a psychiatrist, a field where absolutely everyone you meet is an expert.

Anyway, where you stand on Dan is likely going to indicate where you stand on the treatment of Depression.

Is Depression:

  1. A major common medical condition with a high level of morbidity and mortality, that should be treated by experts in the NHS with proven treatments? Or:
  2. A medical metaphor for the stresses of modern living, that should be treated by creative people broadening one’s outlook?

Those of us sensible enough to realise that our bodies are made of molecules still enjoy putting things into them to help them work better and we would use computer parts if we had ports on our bodies, like Jude Law in eXistenz.

For us, if you’re walking away from the GPs without a prescription in your hand, at some deep level you feel that your mission has failed. Now there’s a win / win solution. Regardless of your condition, however big a hypochondriac you might be, you still collect a script. But instead of taking it to Boots and running the gauntlet of their ‘counter intuitive’ queueing system, now you can take it to the library instead and exchange it for some Bibliotherapy, aka books.

The downside of this is that you are at the mercy of your GP in terms of reading material. The other downside for the library is that it becomes a germ exchange and none of the staff use alcohol gel, not externally anyway.

Quite likely your GP, in the last of your eight minutes of consultation time, will rush the all important choice of book and palm you off with The Hunt for Red October. I can just see a bit of confusion ahead, down to the fact that doctors call collecting information from patients ‘taking a history’. e.g:

Patient: I want to take some History

Doctor: That’s my job.

Patient: Can you prescribe me a bit of Dan Snow?

Doctor: No, but we do have some Dan Brown left over.

87. You know I hate to ask, but are friends electric?

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A patent magneto electric machine. USB C adaptor is $40 extra.

In August, I took an Australian visitor to Lincoln Castle for a good slice of History. Everywhere there were flamboyant characters in Victorian outfits and I soon realised Lincoln was hosting a steampunk festival and we were getting more History than just the Magna Carta.

Officially called The Asylum Festival, the event centred on The Lawn hospital, near Lincoln Castle, an early nineteenth century building which, until 1985, served as a mental hospital.

In this case, and in general, it’s easy to argue that steampunk is filling not just a building but also a cultural void at the Lawn vacated by psychiatry, at least in terms of celebrating the Gothic.

According to wikipedia, Steampunk refers to a subgenre of science fiction and sometimes fantasy that incorporates technology and aesthetic designs inspired by 19th-century steam-powered machinery.

Contrast with Psychiatry, which refers to a subgenre of medicine and sometimes fantasy that incorporates technology and aesthetic designs inspired by 19th century electrical-powered machinery.

Another attempted definition of Steampunk is ‘modern technology—iPads, computers, robotics, air travel—powered by steam and set in the 1800’s’.

Again, contrast with psychiatry, which is all about old ideas (mental energy, chemical deficiencies, mindfulness etc) set in a concrete building on a business park modelled on George Smiley’s HQ.

The point is, Steampunk celebrates the art of anachronism, whereas psychiatry regards it with a mixture of hatred and denial.

The Lawn was opened in 1819, which was before the reign of Queen Victoria, but most of the British Asylum hospitals were built during the Victorian period. Many of them were gothic in style, making them a suitable venue for wearing top hats and tinted goggles, riding round on penny farthings and racing steam robots.

Nowadays, psychiatry is shy about its Victorian heritage. The contribution of Freud and his colleagues is celebrated only in terms of a sprinkling of multiple choice questions. Freud’s early work would now be called Neuroscience and we know that he was intrigued by nerve tissue and would have taken a much more Electric road, if only he’d had access to multipacks of AAA batteries or a USB charger.

Freud knew that the brain was electrically powered – indeed this discovery went back to the end of the eighteenth century. He attributed symptoms like hysterical paralysis to mental energy short-circuiting down the wrong pathways.

Since the Victorian era of psychiatric treatment, electricity popped up as a treatment option at frequent intervals. Nowadays there are many people working on various kinds of electrical brain stimulation, such as deep brain stimulation, transcranial direct current brain stimulation (tDCS), magnetic stimulation and the original and genuine product, ECT.

This is not, you understand, the official penchant of British psychiatry, which by convention pretends to emphasise social and psychological approaches. You’re supposed to listen actively for at least five minutes before getting the talk round to tablets and quite a bit longer before mentioning the E word. That’s just a convention. I wouldn’t call it hypocritical, more, let’s say ‘dual mode’.

People say they want to be listened to more than anything else, but that stance also can be a little dual-modish. Quite a number of patients are in search of physical treatments of one kind or another and want to seek medical advice before buying batteries and sponges from B and Q.

Talking yes, counselling certainly, making a few changes to your life, I guess so, but hey, just tossing an idea out there, how about electricity?

Sadly, the custodians of ECT, psychiatrists and their colleagues in mental health trusts, have completely failed to market their product at all. The number of people prescribed ECT has declined dramatically over the years. Depending on where you stand on this argument, either it is being enormously under-utilised or you can’t believe it’s still going on at all.

Because the NHS mainly seeks to discourage people turning up to use its services, nothing much has been done to promote electrical treatments. The premises used are a bit drab and though they are strictly regulated, the ambience is a bit like the blood – doning centre, being a strange mixture of homeliness and apprehension.

After ‘One Flew over the Cuckoo’s Nest’ was made and shown to generations of students, the Royal College decided that ECT could never be made to look cool ever again.

Regulators like NICE narrowed down the number of indications and the treatment itself changed a lot subsequent to most of the controlled trials that were conducted.  A different anesthetic is used, the energy level has been reduced, the ECT box is not made of mahogany any more and some units don’t even provide free toast after treatment. Arguably, the toast issue has been the most damaging.Whereas 6 to 8 treatments used to be standard in the toast era, now it’s often 12.

I doubt if ECT will be hived off to the private sector, but it wouldn’t totally surprise me to see new departments of electro-therapy in different settings, like sports medicine clinics or the corner of Debenhams.

Unlike ECT, tDCS has acquired a better vibe, being used by the Air Force to keep people concentrating and allegedly by students to improve their performance in games and exams. Perhaps more psychiatrists should be looking at it, but they won’t hurry because they are still struggling with their electrical baggage.

Steampunks would be delighted with a treatment like tDCS that was invented in 1798, but psychiatrists haven’t yet learned to love and embrace the anachronisms of modern life. 

 

 

86. Setting food on fire: not really politics and not really science.

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Warning: hair fires are getting more common.

Behavioural activation is one thing, but most therapists wouldn’t recommend attacking a breakfast cereal cafe in Shoreditch with fire torches, even if such action seemed to strike at the heart of the neoliberal orthodoxy. As a child, I remember putting various kinds of food on to an open fire to see how well they burned. Result: cereals burn extremely well. Discussion: a packet of Ricicles with the top torn off is virtually a Molotov Cocktail. Have people learned nothing from the great fire of London?

There must be better ways of challenging gentrification. Karl Marx spent years in the great reading room at the British museum, working out how to win the class struggle. Possibly he over-thought the whole thing, but direct action against muesli wasn’t on his agenda.

As the person next to you in the waiting room might say, let me tell you about my latest hallucination. I was half asleep at the time, so the experience would be of no interest whatsoever to a psychiatrist. ‘Hypnagogic’ or ‘hypnopompic’, both suitable names for an electropop band or a small disco in Albufeira, are words to denote an experience that occurs when you are just dropping off or waking again. Such things are firmly in the ‘that’s- yawn-normal’ category and would only rate a single line on page 119 of a psychopathology textbook, even if anyone was still writing those.

Anyway, here’s what it was like. It was a circular image, on the lower half of my left visual field. It was brightly coloured but hard to make out. There seemed to be a mountain and on top of the mountain something like a person. There was no sound, but somehow the words ‘good works’ became associated with it, though the words were not spoken.

That’s it. But what to make of it? A trip to the slightly-over-intimate optician at Specsavers, or start a new religion?  One explanation of why we dream is to allow the rehearsal of potential responses to feared scenarios. Primitive peoples would have dreamt of being attacked by wild animals but now we dream about how we would turn the water off if the pipes burst – you may have different nightmares, but you should still install service valves for each appliance.

In the dream scenario, we appear to be paralysed and unable to take necessary action. This is supposed to be because these dreams occur in REM sleep, when the body’s motor system has been taken off-line for maintenance. But this is not helping me interpret my vision. It’s unlikely that a man on a technicolor mountain will give me instructions, if only because there are no mountains where I live, unless you count the coal tips at the power station.

Good works could mean a number of things, but I’m sensing the gist of it as behaving more constructively or generously or just more usefully. At the very least ‘good works’ means I’m not going to pursue my latest business idea, which is a range of homeopathic soups, provisionally titled ‘Memories of Heinz’. And it probably means stopping putting opportunistically low best offer bids on ebay items, just in case the seller is desperate to raise money.

Decades ago, I remember Father Higgins causing a stir when he seemed to go against the idea of Prayer. I think what he said was that you are judged on what you do, not what you think or say. Looking at that now, it doesn’t seem too controversial, following all the scandals that hit the churches. People were clearly behaving badly yet talking sweetly to the boss.

At a meeting this week I found myself in the coffee queue, behind an eminent colleague. I noticed him place his cup just slightly off beam below the dispensing nozzle, so that he got the full quota of frothy milk, but none of the squirt of coffee, which comes out about an inch to the left of centre. I watched the coffee spurt to the side of the cup and I watched him not notice. I watched him take a slurp of his coffee and complain it didn’t taste of anything. Why didn’t I say something? Answer: too much thinking and not enough behaviour, just like Karl Marx.

Getting the balance right between thinking, emotions and behaviour is what therapists do – on diagrams. The point of my dream, I think, is that behaviour comes first and we should help colleagues operate coffee machines even if they work for NICE.

Lots of strands of information feed into our dreams. If ‘good works’ means something to do with behaving better, then it does chime with some of the stuff I wrote about last year. I suggested that behaviourism had been abandoned prematurely in favour of cognitive approaches. I suggested that Art and Music and other skills therapies had been neglected in favour of talking. And I praised hunter / gatherer activities, or pottering, which is the natural human condition. I attempted to steal Nike’s slogan ‘just do it’ to symbolise putting the B back into CBT.

People are abandoning old assumptions about how to protect against sadness and anxiety. They are resorting to eclecticism and mixtures of lifestyle improvements and increasingly, to apps connected with social contact and fitness. Not to mention the people who are connecting batteries to special hats to improve their exam performance, or using Nitrous Oxide to make TV more enjoyable.

This is heretical, but merely running for miles is not a good work. That is why athletic activities have to be artificially and laboriously associated with charitable causes before they acquire a moral value. This is even more heretical but I venture to suggest that neither knitting nor chatting nor a combination of the two are intrinsically valuable activities. It’s easy to say what isn’t a good work; much harder to say what is. Here are my first thoughts on the matter, in the form of a multiple choice question.

Which of the following is a Good Work?

Donating one of your spare copies of Songs about Jane by Maroon 5 (statistics show there are on average 2.6 copies per household) to Cancer Relief.

A mindfulness based breathing exercise, such as blowing up a balloon, pausing to enjoy the pleasing tension in the larynx and the slight dizzy sensation caused by lowered pH.

One short burst of primal screaming followed by a cigarette

Writing down a negative thought using lemon juice as invisible ink, revealing it with a hair dryer and then burning it

Playing the Killers’ song ‘Everything will be alright’.

A friend tells me the man on the mountain sounds like Moses, the person who probably invented bullet points and coined the word ‘covet’. Moses set fire to lamb at times but not I think as part of an informal science experiment.

85. Facing the inevitable barrage of organic fruit.

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Body language gets you 90% of the marks.

 

The summer of love officially begins with The Royal College of Psychiatrists annual congress, starting on June 29th at the ICC. If you’re going to Birmingham, be sure to wear some flowers in your hair.

We know we will be picketed and probably ridiculed by groups opposed to psychiatry. A warning has gone out to wear proper ID and beware bogus journalists.

But, just maybe, this time around, instead of fighting off the pickets with laser pointers, pretending they are light sabres, we should just let our critics put us in the stocks, if they still have them in Birmingham – I know they still have the bull ring – and wait to get pelted with fruit. Waitrose organic blueberries would be acceptable.

I’m talking about Truth and Reconciliation again. We have to accept that Psychiatry as we know it is a twentieth century phenomenon, running on empty these last few years. It’s time to face our critics and recognise what we did.

We are accused as follows:

  • Started using bullet points, against the advice of the English teachers
  • Colluded with the drug companies to hype SSRIs and Atypicals so that huge amounts of money were wasted paying for drugs that were no better than older drugs that were dirt cheap.
  • Conspired to medicalise swathes of  human behaviour like normal sadness and over-activity in children, yet failed to offer any useful treatments for these problems.
  • Colluded with management and politicians to shut down all our asylums and most of our inpatient units, knowing full well that they would not be adequately replaced with community services.
  • In the name of public safety diverted most of what resources remained to locking people up in secure units and hanging on to them as long as possible.
  • Colluded with managers to implement electronic records, knowing that these would destroy anyone’s ability to write or find a narrative summary.
  • For the nicest of reasons, presided over a decline in the status of medical staff, ending up with no secretarial support, no office, nowhere to park, no say in how things are run, quitting or retiring early, no-one wanting to take our places and decaffeinated coffee.

If you’re going to Birmingham, be sure to wear some flowers in your hair. Like Belladonna. A crown of thorns is taking it too far.

As Scott McKenzie would put it: ‘There’s a whole generation, with a new explanation’.

I’m looking forward to hearing it, the explanation I mean. See you in the Bull Ring.

84. Learning lessons from cleverer sorts of creature.

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Dolphins. They don’t do SATS.

Matisse and Chase are action dogs who won Britain’s got Talent. The fact that dogs can be taught to walk across a tightrope should make the education establishment pause briefly over its tall latte. As legions of children are subjected to ever-changing methods of learning and testing, has it never occurred to teachers that all they need is a packet of food pellets and a buzzer? If not, they should try writing the learning objectives and lesson plans for a dolphin show.

The problem seems to be in the notion that learners need to ‘understand’ things.

Once you start down the road of Understanding, sooner or later, you will lose your way. As Spinal Tap observed, it’s a very thin line between clever and stupid.

The road to understanding ends with a Philosophy experiment, like how Schrodinger’s Cat can be alive and dead at the same time. The pursuit of Understanding has killed off skills learning and almost no-one can walk across a tightrope nowadays, not even Matisse if safety rules are respected. Apparently Matisse hasn’t got a great head for heights.

As I understand it – which I don’t need to – operant conditioning happens as follows: People (or dogs) blunder around randomly, certain behaviours get associated with nice or nasty experiences. This, in turn, makes it more or less likely the behaviour will be repeated. Rewarding behaviours with biscuits or fish allows trainers to create showbiz animals. It’s embarrassing to accept that operant conditioning remains the strongest determinant of our behaviour. But there are examples all around us if we look.

In front of me for instance is a jar of eucalyptus honey, which I am putting on my elbows. Although I have sat through countless hours of training in evidence – based medicine and statistics, my experiences with honey are completely homespun, not to say stupid. Like most experiments, it started randomly at a hotel somewhere. A particular constellation of circumstances occurred: sore elbows / time to waste / poor impulse control / spare sachet of honey / no-one looking / short sleeves / suspension of disbelief / random fluctuation of self limiting condition / not liking honey as a food.

Add to that perhaps the knowledge that many great discoveries really did happen by chance.

I am not saying – GMC fitness to practice committee, please note – that you should put honey on your sore places. I don’t think I should be doing it myself to be honest, since it is wrecking my reputation and my wool jumpers. And honey just does not fit into a touch-screen world.

I’m aware I am falling victim to Attribution Error. Being aware of it doesn’t stop it happening though. Placebo can still work, even if the subject is told it is a placebo. Even if there are neon lights flashing the word ‘Placebo’ in front of you and a fifty-strong male voice choir singing the word ‘Placebo’ right behind you. That’s why Understanding just isn’t necessary and might even be dangerous.

Which is also why it may not be quite as necessary to try and explain things as the current versions of User Involvement dictate. Some psychiatrists have got into trouble saying stupid things to patients in an attempts to explain how drugs work. The worst thing you can say, apparently, is ‘chemical imbalance’. It’s OK to say ‘chemical’ I think – though some people struggle with the notion that the brain is made of atoms –  it’s the ‘imbalance’ part that does the damage.

Once you start using words like ‘imbalance’ you can be sure you’re on slippery foundations. Next thing you’ll find you’ve said ‘Time’ or ‘Nature’ or ‘Rest’. Then its only a short step to mumbling something like ‘striving officiously against the inevitable darkness’ and ‘tickets to Switzerland’. If you say the words ‘balance’ or ‘imbalance’ you will hear the examiners screaming with laughter behind their one way mirror.

Psychiatrists might use the word ‘deficiency’ in the context of brain chemistry, but not ‘imbalance’. Not that deficiency (e.g. of serotonin) is a proven cause of depression. But the monoamine theory of depression did guide people’s understanding of the illness for many years. ‘Increasing’ serotonin was the simplistic explanation for how antidepressants might work, particularly those named serotonin re-uptake inhibitors.

There are reams of internet pages given over to an argument between anti-psychiatrists and the psychiatric establishment about whether any psychiatrist has actually used the phrase ‘chemical imbalance’. And indeed as to whether the monoamine theory included notions of balance.

Further reams explore whether it was a term that used to be used but has now been abandoned and the usage covered up, like documents in 1984.

Anti-psychiatrists  argue that psychiatrists concocted the notion of Imbalance with big pharma, in return for free logo pens. One of them scoured the literature to find use of the ‘I-word’ and came up with this example from a 2003 textbook:

Sometimes the explanation is as simplistic as ‘a chemical imbalance,’ while other patients and families may request brain imaging so that they can see the possible psychopathology or genetic analyses to calculate genetic risk’

As far as this paragraph goes, the stupidity of the chemical imbalance part is overshadowed by the rest of it, such as the idea of seeing psychopathology on an image of the brain. Even so, the usage seems to be an example of low-end explanatory waffle, rather than as a deliberate falsehood the board of Eli Lilley dreamed up as they circled their cauldron.

When talking about drugs, or honey, smart people know how to say ‘I don’t know’ But it’s not OK, as Ed Milliband found out at the election, to say ‘who cares?’

Just to reassure you, I am not keeping the medicinal honey anywhere near the food honey, and I have labelled it ‘Medicinal Use Only’ and ‘Not for Internal Use’, just like the Boots chemist would have done in 1965. It works by Osmosis I think, which is quite different from correcting an imbalance.

83. Bandwagon for sale, very low mileage.

A concrete windswept piazza, early in the morning, before the philosophers arrive.

I tried to warn the Liberal Democrats about the negative halo effect that occurs when anyone talks about mental illness in the media. As soon as the talk gets round to mental health, people become upset and change channel, without even knowing why. Not only that but they get grumpy and choke on their pop tarts. The reaction is deeply intuitive, like a brain stem reflex.

The Libs banged on about mental illness affecting one in four of us and needing to be put on the same footing as physical illness services, eliminating suicide etc, just as though they hadn’t read this blog. They didn’t listen and now they are a burned out ruin on the hard shoulder of politics.

Though the halo effect has been known for more than 50 years, this has not stopped a succession of doomed public awareness campaigns such as ‘defeat depression’.

We know that mental health information is perceived as toxic, but no-one has adequately explained why.

Since Shirley Star’s studies of public opinion in fifties USA, the consistent findings have been that people with mental illnesses are regarded as dangerous and unpredictable. Presumably, so too are violent criminals, but they get massive media coverage and scrutiny. Most likely, the ingredient that puts people off dealing with mental health is having to try and understand it. Once you start to think about it, even if you’re in the business, there’s a large parcel of mental work to be done before you can process the information.

For instance, drawing the line between unhappiness and depression, separating personality disorders from illnesses from disabilities, let alone facing the mind brain problem. We’re pretty quickly into Melvyn Bragg territory, but without his panel of expert communicators.

It’s exactly the same for other specialists. A motor mechanic recently tried to explain to me – in some detail – about what had gone wrong with the car’s air conditioning. I remember the phrase ‘wobble plate’, but to be honest that’s the only thing I can tell you about it now. I’ve had to abandon any smug pretensions to knowing my way round a Compressor. Though I will, soon, find an opportunity to say the words ‘wobble plate’, somehow or another.

I’d compare the negative halo to the effect of encountering a protest demonstration in a shopping centre.  First instincts are to avoid it, not particularly in case of violence, but more in case you are called upon to examine a complex issue, like whether a remote area of a foreign country has been shabbily treated. Thinking is the last thing you want to do in the Arndale Centre. But it’s the kind of thing you might do by listening to Radio 4 at about 8pm, alone in your car on a smooth stretch of highway. But then that’s your choice, if you’re in the mood for mental activity.

Outside the police station, a large sign reads PRIDE. I’m going slowly enough to recognise that PRIDE is an acronym – after each capital letter is a smaller word. Subliminally, I perceive the words to be: Pride, Respect, Integrity, Dedication and Empathy. Are these virtues (or sin, in the case of pride) really top of our list of desirable qualities in a police service? Surely, these are not the words you want to hear when the machetes are waving and the AKs start popping.

Having said that, I’ve had no success in weaving an acronym from the words, Taser, Cuffs, Tear-Gas, Smith, Wesson, Court and Prison.

Doubtless the police have their reasons for presenting themselves as social workers, such as the diminished number of real social workers. And obviously they have to try and maintain the moral high ground. Nevertheless, my brain stem reaction to the PRIDE sign was: misguided PR campaign. People are proud of the police because they stand up to horrible people, not because they are empathic. Bad Boys 3 will not be subtitled Good Boys.

The negative halo effect cannot be countered by dressing things up. On the contrary, we are set on guard most acutely by any hint of deception. Very large and fast neural systems are devoted to spotting trickery. It takes a lot of considered reflection to counteract such defences, which means weighing things up carefully. The very thing that stresses out the wobble plate.